Preoperative chemoradiation with oral capecitabine in locally advanced rectal cancers: An impact on sphincter preservation and pathologic response‏

Abstract

Background: Preoperative chemorradiotherapy with concurrent 5-flourouracil (5-FU) has shown superior results as compared to postoperative chemoradiation. Capecitabine, an oral flouropyrimidine, is converted to 5-FU in the body. Our aim was to evaluate the efficacy of capecitabine as radiosensitizer in preoperative chemoradiation of locally advanced rectal cancer.

Methods:From November 2008 to December 2009, 20 patients with locally advanced rectal cancers (≥ T3 or N+), were treated after written consent with concurrent capecitabine (825 mg/m² oral twice daily) with pelvic radiotherapy (dose 5040 cGy in 28 fractions), followed by total mesorectal excision surgery and adjuvant chemotherapy. Primary endpoints were pathologic response rates, efficacy of capecitabine and its toxicity. Pathologic response rates and toxicities were summarized with 95% confidence intervals (95% CI).

Results:The predominant radiological stage was T3 N+ in 40% followed by T4N0 in 35%. The complete pathologic response (pCR) was achieved in 3 patients (15%), the downstaging was observed in 17 patients (85%). Sphincter preservation was reported in 65% cases. The Grade 3 hematological toxicities were lymphopenia (30%) and neutropenia (10%). The Grade 3 non hematological toxicities observed were; diarrhea/proctitis (25%) and nausea/vomiting (25%). No hand foot syndrome or Grade 3 skin toxicity was seen.

Conclusions:The capecitabine as radiosensitizer was well tolerated, more convenient than intravenous 5-FU and with similar response rates in locally advanced rectal cancer.